Tag Archives: informed consent

It amazes me that OBs can still be resistant to testing for progesterone deficiency and treating it. After two consecutive losses and a clean blood panel, I begged my OB to test my progesterone levels. I was pregnant again. Not only did she refuse to test, but she also said that even if I tested low for progesterone, she wouldn’t supplement. Her “brilliant” idea to treat pregnancy loss was Clomid! (You can read tons of stories about women taking Clomid and suffering miscarriages as well as being blessed and challenged with multiple gestation issues.)

I lost that baby at 10 weeks gestation. It died a few weeks earlier. I was devastated and so angry. I’m still angry at that nutjob OB. For numerous reasons I transfered to a more compassionate OB who had been through infertility with his wife and also seemed to enjoy thoughtful discussions with his patients. Although he misdiagnosed my problem, he supported me in seeking a second opinion with a reproductive endocrinologist (RE).

The RE discovered low low low progesterone. The RE also found adenomyosis in my uterus that was distorting the shape of my uterus. He believes that my cesarean caused the adenomyosis. He removed as much as he could.

I received the all clear to TTC and quickly became pregnant again. (Becoming pregnant was never my issue.) I began supplementing with progesterone via 17-hydroxyprogesterone shots. An early ultrasound discovered that I was carrying twins. (Recall the one OB’s suggestion to give me Clomid?!??!!!!!!!)

I continued the progesterone injections and weekly progesterone tests during the first trimester of that pregnancy. My progesterone levels seemed ok on their own, but it was prudent to continue especially since specialists don’t know what a good level of progesterone is for multiple gestation. After three consecutive losses, I carried my twins to term. :)

I accidentally became pregnant during my September 23, 2010 cycle. I suspected it almost immediately after conception, so I began early testing. By CD 28 I tested positive for pregnancy. I contacted my OB’s office (my previous lovely OB died the day he cleared us to TTC in 2008) on a Friday, and was frustrated that it took until the end of the business day on Monday to get a script. In the meantime, I contacted medical friends and even the RE’s nurse. I was amazed that she got back to me and was still willing to advise me . . . 2 years later and from out of state. What a blessing.

Your typical OB isn’t always well-equipped to deal with early pregnancy issues. My OB recommended 100mg oral progesterone. I double-checked this with the RE’s nurse, and she did NOT recommend this treatment. My SIL also told me some sketchy stuff about oral progesterone supplementation. The RE’s nurse said the best thing to do is either go back on the shots or do 200mg prometrium vaginally. Since prometrium is so accessible and doesn’t require a stick in the bum, I went that route. I also want readers to know that it took a while to straighten out the script, but by Tuesday I had what I needed thanks to a lovely independent pharmacist, the RE’s nurse, and the OB’s office following through with exactly what I requested.

I just want to offer this information up for those who are struggling to make sense of their losses. Really, if you think you suffer from low progesterone and/or a short luteal phase, you need a medical script for progesterone supplementation. It is unlikely that natural supplements will do the job . . . maybe for marginal progesterone?

Someone on one of my advocacy lists said that taking prometrium vaginally seemed “iffy” to her. I must admit that irritated me, but she doesn’t know anything about me or how seriously I consider my health decisions. Had I not been directed to this reproductive endocrinologist in 2008, I would probably not have my twins or be 16 weeks pregnant with my fourth and final baby.

This is too complicated and extensive to reproduce here, but essentially a NJ mother’s refusal of diagnostics and “treatments” in childbirth (practices that aren’t evidence based) as well as her refusal to allow a cesarean resulted in her newborn baby being taken from her.

Interestingly enough, the initial reason for her losing her baby (refusing an unnecessarian – the baby was born vaginally without incident) was thrown out of court. However, this woman has a history of mental illness, and evidently the court found this history compelling enough to take her baby away for neglect and abuse. However, she never had a chance to neglect or abuse her newborn since she was taken away immediately following birth.

From what I can tell, she ended up in this horrific situation because:

history of mental illness (this is terrifying; I’m currently medicated for depression and was advised to stay on my meds during pregnancy – do I risk losing my babies at birth if I go AMA?)

refusal of standard procedures in this hospital such as epidural and continuous electronic fetal monitoring

squirming around as hospital personnel tried to MAKE her get an epidural

refusing a cesarean

kicking the OB out of her L&D room

To read more about this case as well as interesting comments from the peanut gallery, see Wise Law Blog’s post and the Volokh Conspiracy’s post. (Unfortunately the commentary at VC’s site turned into a big abortion and feminism flame war between Dillan, Theo, and later John.)

I will say that this family took their chances going to a hospital (St. Barnabas was featured in Jennifer Block’s Pushed) with a 50% cesarean rate. Additionally, I’m not sure if they had a clearly outlined birth plan (possible protection in court?) or cesarean “consent” form which would indicate under which, if any, circumstances she would agree to a cesarean. She also should have had a doula. This family really did go to McDonalds assuming they could get steak anyway. Not good.

This is one of those days that I shouldn’t have gotten out of bed and need to crawl back into bed. Luckily my students are sick, so I am off the hook, so to speak. I don’t feel well myself – in addition to pregnancy fatigue I must be fighting some version of the flu that is going around. I’ve had chills, a migraine, dizziness, and shortness of breath.

Gretchen of Birth Matters posted an important notice from the American Association of Birth Centers. The short of the long of it is that the AABC will not be conducting a follow-up study on VBAC in birth centers. Most AABC accredited birth centers do not allow VBACs. VBACs are evidently not considered to be “high risk” or “low risk”. Rather, we’re an insignificant subset who is someone else’s problem. Instead of conducting a study to correct the faulty conclusions of the previous study (Obstetrics & Gynecology, 2004), they are focusing on maintaining a credible visage for normal birth. (CYA much?)

My sister-in-law has been diagnosed with carrying the “fragile x” gene. As far as I know, the genetic testing took place without informed consent. I resent that my SIL has to spend her entire pregnancy worrying about her future child’s mental and physical well-being. She is only 9 weeks pregnant, so this is a big burden to bear for such a long time. Let’s get back to the “rub”. She did not request genetic testing and was not told that genetic testing was part of the OB’s standard blood work-up. She and my BIL are the picture of health, so there would have been no obvious need for genetic testing. This is a huge problem in a number of ways, and this OB should be hunted down and burned at the stake for what she has done.